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Sure, there are drugs that are worse than others, and seeking to redirect use where possible would be good. Especially when dealing with addicts. Some people d
by vidarh 3y ago
Sure, there are drugs that are worse than others, and seeking to redirect use where possible would be good. Especially when dealing with addicts.
Some people do seek out opiates especially because of its specific effects, and I don't think you can entirely prevent that, though you may be able to reduce it with better mental health support, but even then you could also redirect use to safer options, and also segmenting out those seeking opiates from those seeking party drugs etc. so that you don't create pathways between them might well be beneficial.
To stick with my heroin example, I don't know where specifically heroin sits relative to opiates that would actually satisfy existing addicts and that's part of the challenge, but heroin itself is also nowhere near the worst opiate, and one of the negative effects of the current way we're handling this is that we've created a pathway towards more dangerous ones.
E.g. a frequent pathway to heroin use today is from oxycodone, to oxycodone on the black market after you lose your prescription, to heroin. But then it gets worse: Dealers cutting heroin with fentanyl or even carfentanyl.
Getting users nudged gently or not so gently towards the safest options that will satisfy them would in itself likely help a lot, and of course, a black market dealer has no incentive to do that unless there's a very severe difference in how they're treated by law enforcement.
Perhaps a variant of what you described would be a good first step in many places not ready for more decriminalization: Much more aggressively segmented drug sentencing by the harm of the worst drug a dealer can be connected to, and perhaps even explicitly punish "crossover" between drugs with differ harm profiles to reduce the pathways between them.
But that means being honest about the abuse potential, and not politicizing it, and that is in itself an uphill battle in many places.
- pbronez 3y agoIs it possible to keep an addict satisfied with a lower tier drug? Genuine question. My understanding is that opiates become less effective over time as your body adapts, so you seek out stronger drugs in larger doses.
- vidarh 3y agoIt really depends both on what you mean by "lower tier" drug, and what people are seeking, and how frequent users they are. But I suspect a reliable potency alone would do a lot for slowing the upward creep than shunting people to a drug dealer who might decide you'll be a more profitable customer if they raise your expectations of the high to seek by selling you "heroin" without telling you it's not pure heroin but cut with fentanyl (tens of times as strong) or carfentanil (thousands of times the potency). Even with an upwards creep, there are vastly different strength levels and harm profiles for different opioids, and a strategy of what is available focused on slowing advancement and steering around the most dangerous options might well allow for keeping people on far milder options for far longer and/or give more options for shunting people onto interventions if they want to stop. The first step is really to accept it's a healthcare problem, and recognise that it's a worse healthcare problem if people go to drug dealers because you refuse them. If so, the question becomes not necessarily about a free for all, but about how many hoops you can get people to jump through to shunt as many as possible in a healthier direction without making too many decide it's easier to buy from a dealer.
- alephnullshabba 3y agoLarger doses yes, but the opiates being consumed are almost entirely a result of cost/availability. Genuine prescription pills are by far the most desirable choice amongst opiate addicts, but tight control on supply post opiate-crisis has made them practically nonexistent in illegal drug markets. The extent of prescription opiates desirability is somewhat evidenced by most "street" fentanyl being consumed in counterfeit oxycodone/vicodin pressed-pills. And then of course there is cost--why smuggle 50 packages of heroin when a single package of fentanyl contains an equivalent number of opiate doses and can be manufactured far more efficiently/discretely? But in general the opiate market is defined by the practical constraints of cost and availability. Fentanyl is a synthetic opioid that has been used in hospitals for decades, but its emergence as a street drug in recent times is the result of precursors and synthesis methodology becoming very accessible
- trogdor 3y ago>Is it possible to keep an addict satisfied with a lower tier drug? Yes, but the person has to want to make the change, since the ‘lower tier drug’ (buprenorphine) doesn’t get them high. It just stops cravings and withdrawal symptoms, while largely blocking the effects of most other opioids. Another benefit of buprenorphine is that it has a ceiling effect in relation to respiratory depression. For most opioids, if you take enough, you will stop breathing and die. Buprenorphine’s dose/response curve for respiratory depression and sedation turns flat after ~24mg, which makes the drug very difficult to overdose on.